LIFESTYLE

A healthcare plan for the young market

Make the most out of life’s precious moments.

With Pacific Cross, you can enjoy healthcare coverage that
helps secure your peace of mind, wherever life takes you.

Here For You

Here at Pacific Cross, we are dedicated to supporting your health and well-­being. We want to help you lead your
life in style – so you can achieve the things you want and deserve. Let Pacific Cross be your trusted ally in your
pursuit of a better life.

LIFESTYLE

Pacific Cross shares your dream of building a healthy and happy life. As
early as now, we want to support you as you work towards achieving and
protecting your dreams. With LifeStyle, we bring you a healthcare plan that
understands your demands and desires as a young person. LifeStyle not
only provides you medical coverage that is suited to your needs at this time,
but also provides you an exciting range of additional benefits designed to
complement the way you live.
? Some things all applicants should know:

As with all healthcare plans, there are some important points you should know before entering into a contract.
In this section, we identify some key Agreement provisions.

1. Your coverage begins 30 days after the date shown on the Agreement. However, you already have immediate coverage
for accidental injury.

2. A Pre-Existing Condition is a disability or illness which existed before the commencement of cover. The existence of a
preexisting condition can be medically determined given its natural history or the manner of development of a disease,
which means you may or may not be aware of its presenting symptoms. Pre-Existing Conditions are also those that are known
to you because you have felt its signs and symptoms regardless if this prompted you to seek for treatment, medication,
advice, or diagnosis. When you answer our Medical Questionnaire, please ensure that you tell us about all your medical
conditions and symptoms happening at any time in the past and/or present, known and/or suspected, whether or not
treatment or professional advice was sought. We will then notify you accordingly of the Company’s decision to cover or
not to cover or to impose special terms.

3. While the Agreement is issued in the Philippines, it can provide Emergency Confinement Coverage when you are overseas
The maximum period of cover should not exceed more than 30 days per trip during the period of coverage.

4. Certain conditions are permanently excluded from being covered. These conditions include:
• Congenital conditions, birth defect and abnormalities
• Artificial implants, durable medical equipment, grafts, prosthetic devices and corrective devices other than artificial limbs
• Cosmetic surgery or related complications, contact lenses, hearing aids and prescriptions thereof, except those that may
be required for reconstructive surgery due to or as a result of an accident
• Suicide, attempted suicide or intentional self-inflicted injury
• Pre-existing conditions unless such have been declared and approved by the Company
• Sexually Transmitted Diseases (STDs)
• All contraceptive methods of birth control; or screening and/or treatment pertaining to infertility
• Pregnancy related expenses and screening, childbirth (including surgical delivery); miscarriage and abortion, including
their complications; pre-natal or post-natal care as well as nursing care for the newborn

5. Your contract is guaranteed renewable up to age 40 and you will be allowed to continue your coverage under our other
higher benefit limit plans. However, we reserve the right to adjust your membership fees and other Agreement conditions
upon written advice 45 days prior to each renewal.

6. Your contract contains a provision on the Member’s right to Free-Look Period.

7. For full details, please refer to the Agreement.

 IN-PATIENT & HOSPITALIZATION BENEFITS

Maximum Coverage Limit PHP 250,000

May be offered to persons 21 to 35 years old. LifeStyle is renewable until age 40. Benefits may be availed of per illness per lifetime
via reimbursement or no-cash-outlay through Pacific Cross’s accredited network. The benefits are in addition
to any benefits recoverable from PhilHealth or any other insurances or indemnities.
BASIC HOSPITAL BENEFITS
Room and Board As charged, up to
including General Nursing Care Private Room category only
Miscellaneous Hospital Expenses As Charged
for required diagnostic laboratory tests; prescribed medicines; physiotherapies; blood and components;
anesthesia; and surgical appliances
Attending Physician’s Visit 1 PHP 800
Daily visit fee to a limit of
Specialist’s Fee 1 PHP 800
for 10 days for each disability, per year to a daily limit of
Private Duty Nurse PHP 800
at home only when certified necessary by Attending Physician to a maximum of five (5) days, immediately
after hospitalization. Daily visit fee to a limit of
Procedure done on an Out-Patient basis Subject to the limit of the
for selected procedures as approved by Pacific Cross Hospitalization benefit
CRITICAL CARE BENEFITS
Intensive Care Unit, Coronary Care Unit, & Telemetry As Charged
maximum of 10 days per disability, per year
SURGICAL BENEFITS
Operating Theater and Recovery Room As Charged
Surgeon’s Fee 1 PHP 50,000
including pre-surgical assessment and normal post-surgical care while the Member is confined in the treatment
country up to a per disability, per year limit of
Anesthesiologist's Fee 1 Not exceeding 40% of the
per disability, per year limit of approved Surgeon’s Fee
Elective Surgery Direct Settlement of covered
scheduled surgery arranged by the Company within accredited network only portion of confinement &
(10-day notice must be given to Pacific Cross by the Client) treatment cost by Pacific Cross
Artificial Limb As Charged
including rental of mechanical devices as approved by Pacific Cross excluding implantable devices
EMERGENCY BENEFITS
Emergency Out-Patient PHP 5,000
for treatment of covered emergency cases/conditions not leading to confinement provided by the Out-Patient
department of a hospital or a licensed doctor in his clinic, maximum limit per disability, per year of
Emergency Dental Services As Charged
due to a covered Accident
Emergency Local Ambulance Service As Charged
from place of occurrence to the nearest hospital facility or from hospital to hospital using land transportation
service. (If local land facility is not available, other transportation facilities are allowed subject to the approval
of Pacific Cross, up to a per disability, per year limit of PHP 15,000.)
VALUE ADDED BENEFITS
Daily Hospital Allowance PHP 300
for up to seven (7) days, per year to a daily limit of
Sports Coverage Included
for recreational sports including skiing and scuba-diving (subject to Agreement limits) other than contact sports
Recreational Contact Sports Coverage PHP 30,000
(e.g., football, rugby, karate, boxing, martial arts and wrestling)
Covers In-Patient, Emergency Out-Patient and Out-Patient availments under an aggregate limit per year of

1
Payment of Professional Fees [Attending Physician’s Visit, Specialist’s Fee, Surgeon’s Fee, Anesthesiologist's Fee] will be based on the Company’s PhilHealth
Relative Value Scale if claims are directly settled by the Company to the Physician or Hospital. The PhilHealth Relative Value Scale shows the values per
procedure as provided by the PhilHealth that the Company will apply for the payment of a particular Professional Fee in an Accredited Network.
VALUE ADDED BENEFITS
Coverage Abroad Unlimited number of
Available for both emergency and non-emergency cases, as well as for availment of Out-Patient benefits. trips per year, 90 days
Coverage abroad is subject to the inner limits of the plan and may be availed of through reimbursement per trip.
only. Pacific Cross may facilitate Direct Settlement of medical expenses, but limited to emergencies leading to
confinement and elective surgery with prior notification and arrangement with Pacific Cross.
Worldwide Emergency Assistance Included
Pacific Cross, through our emergency assistance partner, will provide the assistance and advice (24 hours a
day, 7 days a week) for free but the client will be responsible for any third party charges incurred as a result of
such advice or assistance unless otherwise specified elsewhere in the Agreement. Member must be traveling
100 miles (or 150 kilometers) or more from his primary and legal address or in another country which is not
his Country of Residence for less than 91 days.
Services* include but are not limited to the following:
• Emergency Medical Evacuation: Evacuation under appropriate medical supervision to the nearest
medical facility
• Medical Repatriation: Repatriation under medical supervision to the Member’s legal residence or to a
medical or rehabilitation facility near the Member’s residence
• Return of Mortal Remains: The return of mortal remains will be arranged and paid for.
• Compassionate Visit: When a Member is traveling alone and will be hospitalized for more than (5)
consecutive days, an economy, round-trip, common carrier transportation will be provided to a family
member or a friend to accompany the Member.
• Care of Minor Child(ren): One-way economy common carrier transportation will be provided to the
place of residence of minor child(ren) when they are left unattended as a result of a medical emergency
or death of a Member.
*Availment of services through our designated assistance provider, limit per year of: As Charged
on top of the Maximum Coverage Limit for any covered Accident and Illnesses.
*Availment of services not through our designated assistance provider, limit per year of: As Charged
forms part of the Maximum Coverage Limit
The actual cost will be paid via reimbursement by the Company which will form part of the Maximum
Coverage Limit of the In-Patient/Hospitalization Benefit provided that such assistance is a result of any
covered Accident and Illnesses occurring during the Period of Coverage.

LifeStyle
 PERSONAL ACCIDENT BENEFIT

for accidental death PHP 100,000

OUT-PATIENT BENEFITS

Reimbursement of expenses due to any covered Accident and Illnesses, aggregate limit per year
80% Reimbursement of Out-Patient Benefits for: PHP 25,000
• Consultation in Doctor’s Office: Physician’s Fee and Specialist’s Fee
• Prescribed Medicines and Drugs: for a covered condition or disability and procured from a recognized
pharmacy
• Physiotherapist or Chiropractor; Diagnostic Laboratory Tests and X-rays: necessary for the treatment of a
covered disability
• Other Alternative Treatments: Chinese medicine practitioner, acupuncturist and herbalist. Homeopathy,
Osteopathic Manipulative Therapy (OMT), Bonesetter, Iridology, and any medication prescribed by the
mentioned alternative treatments
50% Reimbursement of Out-Patient Dermatologic Procedures and Medications 2 PHP 5,000
for treatment of acute or chronic skin conditions availed of at any duly licensed clinic, skin and wellness center
or establishment authorized to perform dermatologic procedures or to dispense skin medications.
2
Dermatologic Procedure is a method designed to treat minor skin diseases excluding its appendages
(hairs, sweat glands, sebaceous glands and nails) and is performed without incision or through tiny
incisions instead of one large opening. This benefit is not subject to the Pre-Existing Provision of the
Agreement.

ANCILLARY BENEFITS

Pacific Cross partners with various establishments that value health, wellness, and enjoying life to the fullest.
To support you in pursuing a healthy and well-balanced lifestyle, we bring you rewarding benefits to go with
your LifeStyle plan. Because we want to make LifeStyle more than just a medical plan, we've included some
perks for you to enjoy.

ANNUAL MEMBERSHIP FEE As of 1 September 2019

AGE 21 - 25 26 - 30 31 - 35 36 - 40

Membership PHP 23,549 PHP 25,376 PHP 26,291 PHP 28,120

 Our Companies
Pacific Cross Insurance, Inc. and
Pacific Cross Health Care, Inc.

Pacific Cross is EXCELLENCE.

We are committed to bringing
nothing but the best to our clients.
Our decisions are based on an intricate
understanding of our clients’ needs,
demands and expectations. We strive to
create and innovate programs that will
best serve our customers.

Pacific Cross is STABILITY.

We are one of the leading and most
financially stable companies in the
industry today. Our Premiums Earned in
recent years put us in the top 10 non-life
insurance companies in the Philippines.
Pacific Cross is EXPERIENCE.
We draw from more than 65 years of
experience in the insurance industry.
Our actions are guided by a deep insight
brought about by the knowledge we have
gained through the years.
Pacific Cross is CUSTOMER SERVICE.
We are rooted in a commitment to
ever improving customer service. We
aim to be continuously progressive and
professional. Our commendable track
record and competent support staff
ensure that you are given immediate and
excellent service at all times.
Pacific Cross is a
PARTNERSHIP OF TRUST.
We build and value enduring
relationships. We consistently prove that
we are worthy of the highest confidence
— by our strict standards, the integrity of
our promises and the results we deliver.
In the event of a crisis, we assure you that
Pacific Cross will be your friend and ally.
Get in touch with us today!
Call +63 2 8230-8511
E-mail: mdas@pacificcross.com.ph
HEAD OFFICE
Pacific Cross Center, 8000 Makati Avenue, 1200 Makati City,
Metro Manila, Philippines
Tel. No.: +63 2 8230-8511 Fax No. : +63 2 8325-0638
E-mail: mdas@pacificcross.com.ph
PACIFIC CROSS 8 ROCKWELL
MEDICAL SALES CENTER
Unit 8B, 8th Floor, 8 Rockwell Building Hidalgo Drive, Makati City,
Metro Manila, Philippines
Tel. No.: +63 2 8230-8511 Fax No. : +63 2 8230-8991
E-mail: mdas@pacificcross.com.ph
CEBU
Units 102 & 202, Avagar Building, No. 09, Escario corner Molave Street,
Lahug, Cebu City, Philippines
Tel. Nos.: +63 32 233-5812, +63 32 233-5816, +63 32 416-4468
Fax No.: +63 32 233-5814 E-mail: cebu@pacificcross.com.ph
CLARK
Unit 2, Pavilion Mall, Philexcel Business Park,
Clark Freeport Zone, Philippines
Tel. Nos.: +63 45 499-5424, +63 45 499-5428
E-mail: clark@pacificcross.com.ph
DAVAO
2nd Floor, Left Wing, Door No. 6, Matina Town Square,
Mac Arthur Highway, Matina, Davao City, Philippines
Tel. No.: +63 82 297-7314 Telefax: +63 82 297-7151
E-mail: davao@pacificcross.com.ph

www.pacificcross.com.ph V09.19

We also have Agency Offices in:

Luzon: Baguio | Batangas | Cavite | Laguna | Naga | Olongapo | Pampanga | Palawan
VisMin: Bacolod | Bohol | Butuan | Cagayan de Oro | Dumaguete | General Santos | Iloilo | Ormoc | Tacloban